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Using a Split-belt Treadmill to Evaluate Generalization of Human Locomotor Adaptation
Published on: August 23, 2017
Associations of supported treadmill stepping with walking attainment in preterm and full-term infants
Hong-Ji Luo1, Pei-Shan Chen, Wu-Shiun Hsieh
1School and Graduate Institute of Physical Therapy, National Taiwan University College of Medicine, Taipei, Taiwan.
Insights
Supported stepping on a treadmill can predict walking attainment in infants. Specific step parameters identified at 7 months accurately predict early walking or delayed attainment in preterm and full-term infants.
Area of Science:
- Developmental Pediatrics
- Motor Control
- Rehabilitation Science
Background:
- Supported stepping on treadmills is used in rehabilitation for children with neurodevelopmental issues to promote early walking.
- Limited data exists on the developmental link between supported stepping and independent walking.
Purpose of the Study:
- To longitudinally analyze supported stepping in preterm and full-term infants.
- To identify step parameters that predict walking attainment.
Main Methods:
- Longitudinal cohort study design.
- 29 preterm and 20 full-term infants assessed bimonthly for supported stepping from 7 months corrected age.
- Cox regression and logistic regression used to analyze associations between step variables and walking outcome.
Main Results:
- Preterm infants achieved walking later (12.8 months) than full-term infants (11 months).
- Alternating steps, hip-knee/hip-ankle correlation, and asymmetry ratio (AR) of stance time at 7-9 months predicted walking age.
- Specific step features at 7 months predicted walking before 11 months (75-77% accuracy); failure to meet these predicted delayed walking by 15 months (72-98% accuracy).
Conclusions:
- Walking emergence involves coordinated patterns in supported stepping.
- Identified step predictors can guide treadmill training for infants with delayed walking.
Background:
Treadmill training in supported stepping has been used as part of rehabilitation programs for children with neurodevelopmental problems to facilitate earlier onset of walking. However, information concerning the developmental continuity between supported stepping and walking is limited.
Objective:
The aims of this study were to longitudinally examine supported stepping in preterm and full-term infants and to explore the step parameters associated with walking attainment.
Design:
A cohort study with a longitudinal follow-up design was used.
Methods:
Twenty-nine preterm infants and 20 full-term infants were examined bimonthly with supported stepping on a treadmill from 7 months of age until walking attainment or 18 months of corrected age. The associations between step variables and walking outcome were examined using Cox proportional hazard regression and logistic regression.
Results:
Walking attainment for preterm infants was later than for full-term infants (median = 12.8 versus 11 months, respectively). The percentage of alternating steps, hip-knee correlation, hip-ankle correlation, and asymmetry ratio (AR) of stance time of stepping movement from 7 to 9 months of corrected age were found to be associated with age of walking attainment in all infants. Manifestation of at least 3 of 4 step features (ie, > or = 80% alternating steps, < or = .37 hip-knee correlation, > or = .73 hip-ankle correlation, and < or = 1.40 AR of stance time) at 7 months predicted walking attainment prior to 11 months of corrected age (accuracy = 75%-77%). Failure to achieve such competencies at 7 or 9 months of corrected age was predictive of failure in walking attainment by 15 months (accuracy = 72%-98%). Limitations The limitations of this study included a small sample size and commencement of stepping assessment as early as 7 months of corrected age.
Conclusions:
The emergence of walking may involve cooperation of alternating pattern generation, interjoint coordination, and interlimb coordination in supported stepping in preterm and full-term infants. The identified step predictors may assist clinicians in designing appropriate treadmill training programs for those infants with delayed walking.
